Circumcision: Information for parents by the Canadian Pediatric Society

I recommend reading The Canadian Pediatric Society’s position paper on circumcision found here:http://www.cps.ca/en/documents/position/circumcision

Principal author(s)

E Outerbridge; Canadian Paediatric Society, Fetus and Newborn CommitteeCMAJ 1996;154(6):769-80

Abstract

Objective: To assist physicians in providing guidance to parents regarding neonatal circumcision. Options: Whether to recommend the routine circumcision of newborn male infants.
Outcomes: Costs and complications of neonatal circumcision, the incidence of urinary tract infections, sexually transmitted diseases and cancer of the penis in circumcised and uncircumcised males, and of cervical cancer in their partners, and the costs of treating these diseases.
Evidence: The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed.
Values: The literature was assessed to determine whether neonatal circumcision improves the health of boys and men and is a cost-effective approach to preventing penile problems and associated urinary tract conditions. Religious and personal values were not included in the assessment.
Benefits, harms and costs: The effect of neonatal circumcision on the incidence of urinary tract infection, sexually transmitted diseases, cancer of the penis, cervical cancer and penile problems the complications of circumcision; and estimates of the costs of neonatal circumcision and of the treatment of later penile conditions, urinary tract infections and complications of circumcision.
Recommendation: Circumcision of newborns should not be routinely performed [Emphasis mine–FR].
Validation: This recommendation is in keeping with previous statements on neonatal circumcision by the Canadian Paediatric Society and the American Academy of Pediatrics. The statement was reviewed by the Infectious Disease Committee of the Canadian Paediatric Society. The Board of Directors of the Canadian Paediatric Society has reviewed its content and approved it for publication.
Sponsor: This is an official statement of the Canadian Paediatric Society. No external financial support has been received by the Canadian Paediatric Society, or its members, for any portion of the statement’s preparation. http://www.cps.ca/en/documents/position/circumcision

This following article, part of a brochure, was taken from a sub-site of the Canadian Pediatric Society’s website, CaringForKids.cps.ca The original can be found here: http://www.caringforkids.cps.ca/handouts/circumcision

Circumcision: Information for parents

 Circumcision of baby boys is a surgical procedure to remove the layer of skin (called the foreskin or the prepuce) that covers the head (glans) of the penis and part of the shaft. It is most often done during the first few days after birth.

Circumcision is a “non-therapeutic” procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor.

After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.

Risks and benefits of circumcision

Problems from the surgery are usually minor. Although serious complications are rare, they do occur. Newborn circumcision has been associated with surgical mistakes, such as having too much skin removed.

Of every 1,000 boys who are circumcised:

  • 20 to 30 will have a surgical complication, such as too much bleeding or infection in the area.
  • 2 to 3 will have a more serious complication that needs more treatment. Examples include having too much skin removed or more serious bleeding.
  • 2 will be admitted to hospital for a urinary tract infection (UTI) before they are one year old.
  • About 10 babies may need to have the circumcision done again because of a poor result.

In rare cases, pain relief methods and medicines can cause side effects and complications. You should talk to your baby’s doctor about the possible risks.

Of every 1,000 boys who *are not* circumcised:

  • 7 will be admitted to hospital for a UTI before they are one year old.
  • 10 will have a circumcision later in life for medical reasons, such as a condition called phimosis. Phimosis is when the opening of the foreskin is scarred and narrow because of infections in the area that keep coming back. Older children who are circumcised may need a general anesthetic, and may have more complications than newborns.

Circumcision slightly lowers the risk of developing cancer of the penis in later life. However, this form of cancer is very rare. One of every one million men who are circumcised will develop cancer of the penis each year. By comparison, 3 of every one million men who are not circumcised will develop penile cancer each year.

Caring for an uncircumcised penis

The foreskin covers the shaft and head (glans) of a boy’s penis. During the early years of a boy’s life, the foreskin separates from the glans. This is a natural process that occurs over time. You do not need to do anything to make it happen.

When the foreskin separates, it is said to be “retractable,” meaning it can be pulled back.

An uncircumcised penis is easy to keep clean and requires no special care:

  • Keep your baby’s penis clean by gently washing the area during his bath. Do not try to pull back the foreskin. Usually, it is not fully retractable until a boy is 3 to 5 years old, or even until after puberty. Never force it.
  • When your son is old enough, teach him to keep his penis clean as you’re teaching him how to keep the rest of his body clean.
  • When the foreskin separates, skin cells will be shed and new ones will develop to replace them. These dead skin cells will work their way down the penis through the tip of the foreskin and may look like white, cheesy lumps. These are called smegma. If you see them under the skin, you don’t need to force them out. Just wipe them away once they come out.
  • When the foreskin is fully retractable, teach your son to wash underneath it each day.

If you decide to have your baby boy circumcised

It is helpful to talk to your baby’s doctor about the issues involved in circumcision:

  • Cost: Circumcisions for non-medical reasons are not covered by all provincial and territorial health plans.
  • Possible complications, such as the ones described above.
  • Pain relief:
    • Newborn babies do feel pain. Without pain relief, circumcision is painful. Acetaminophen (such as Tempra or Tylenol) or EMLA cream, which numbs the skin, won’t be enough.
    • There is more than one way to do a circumcision. Studies show that the amount of pain depends on what method is used. The Mogen clamp seems to cause less pain than the Plastibell or Gomco technique.
    • Your baby will need a local anesthetic (dorsal penile nerve block or subpubic block technique), given by a needle in the area where the circumcision is done. EMLA cream should also be used to reduce the pain of giving the needle for the anesthetic.
    • Anesthetics do carry risks, and the needle can cause bruising or swelling.
    • Sucking on a pacifier or gauze soaked with a sugar solution may help relieve the pain.
    • Your baby should receive acetaminophen when the local anesthetic wears off. It should be given for 48 hours, or longer if he is still uncomfortable.

Caring for the circumcised penis

  • After the circumcision, you can help comfort your baby by holding him and nursing him often.
  • The penis will take 7 to 10 days to heal. The area may be red for a few days and you may see some yellow discharge, which should decrease as it heals. Talk to your baby’s doctor about what to expect.
  • Keep the area as clean as possible. Wash gently with mild soap and water, and be sure to clean away any bits of stool. If there is a bandage, change it each time you change your baby’s diaper. Use petroleum jelly (Vaseline) to keep the bandage from sticking.
  • * Call your doctor if:
    • You see more than a few drops of blood at any time during the healing process.
    • The redness and swelling around the circumcision do not start to go down in 48 hours.
    • Your baby develops a fever (rectal temperature of 38.0° C or higher).
    • Your baby seems to be sick.


Reviewed by the following CPS committees:
Community Paediatrics Committee
Fetus and Newborn Committee

Last updated: November 2004

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3 thoughts on “Circumcision: Information for parents by the Canadian Pediatric Society

  1. Gabriele says:

    “The penis will take 7 to 10 days to heal.” Healing? Not really! The glans will now be exposed and this leads to Irritations on the remaining nerves at each friction by clothing. The same happens to circumcised girls. For the rest of their life.

    • Francis Roy says:

      That’s how long the wound takes to heal until the point where infection and reopening is no longer a concern. As for the irritation of clothing, I myself don’t experience it.

  2. No Mention of “DEATH” as a possible outcome for needlessly cutting healthy tissue off of a NON-CONSENTING patient. If circ was banned on minors, (only 18+ can consent to it) I don’t think there would be a rush of adult males requesting they be circumcised, this is why the animals torture innocent babies that cannot protect themselves. Take the choice away from men and if they complain belittle them, make fun of them so they stay silent on this issue…..

    And for those that don’t think this is ANTI-MALE Choice, think of the statement “and of cervical cancer in their partners” two problems, 1- Would anyone on earth, even DARE say or even think, that a female should permanently alter her body for the SLIGHTEST chance it would benefit a male ? Hell if there was scientific proof that (EVERYONE on earth agrees) altering a female’s body would benefit a male, the world would end…. We would NEVER hear the end of it… 2- Who says that the specific male being mutilated would have sex with a female? Yes the majority of males are heterosexual; however there is no guarantee that this one specific male baby being cut will be heterosexual. (Everyone just assumes he will be) Why should his body be permanently altered on the slightest chance he would harm a female by cancer?

    There are some males that DO have irritation from clothing… imagine having the Male Genital Mutilation scars constantly being irritated, red and at times swollen (no jokes please) it happens but since males are made fun of when they try to speak out, this isn’t considered a side effect…. And some men don’t have the glans being irritated as the keratinization has built up enough to make the glans less sensitive to clothing.

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